Background The DAS28 (disease activity score 28) was created for the purpose of quantifying and comparing inflammatory processes for patients with Rheumatoid Arthritis. One of the four components measured is a 28 joint tender count. The objectivity of this marker is unclear.
Objectives To assess the disease activity of patients with tender joints and compare this to joint ultrasound scans. Can patients be globally tender despite absent joint inflammation on US? And furthermore, is there any correlation between a high tender count and patient anxiety/depression levels?
Methods 47 patients with inflammatory arthritis had their routine DAS28 assessment, as well as joint ultrasound scans to identify Para Doppler activity. Along with the 28 joint counts, 10 reference points were used to identify patients who were globally tender. And finally each patient was asked to complete a HAD (hospital anxiety/depression) questionnaire to assess levels of anxiety and depression.
Results Of the patients with moderate-high DAS28 scores, a subgroup (37-44%) was identified to have no activity on joint US scan. The high DAS28 (>5.1) scoring patients with no disease activity on US scan appeared to have on average a high tender count (26/28 joints) and were globally very tender (8/10 reference points). This subgroup of patients also scored either as a case or borderline for anxiety/depression on the HAD score.
Conclusions Global tenderness and anxiety/depression can result in a misleadingly high DAS28 score in a subgroup of patients with high DAS28 scores, despite absent joint US activity.
Disclosure of Interest : None declared